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With a few exceptions, chronic medical therapy should not be adjusted prior to presentation for surgery. It is prudent to maintain adequate treatment of medical conditions, including administration of oral medications with small sips of water on the day of surgery. Surgery presents problems such as bleeding, fasting, and physiologic stresses that require anticipation prior to surgery. In addition, preoperative examination and testing may dictate the need for the initiation or adjustment of medications.

Chronic medical therapy must be reviewed in a timely fashion before surgery. This review can take place in a variety of settings, including the surgeon’s office, a primary medical provider or specialist’s office, or in a preanesthesia testing unit. A phone discussion may be appropriate in many circumstances. Table 68-1 presents a summary of recommendations. Particular attention should be focused on anticoagulation treatment, including herbal remedies, diabetes mellitus therapy, and antihypertensive treatment.

TABLE 68-1Preoperative Medication Management Recommendations

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